I don’t think anyone would dispute that adult social care needs to change. From the perspective of the Government, much of the media, and many think tanks and campaigning organisations, social care reform means people won’t be forced to sell their home to pay for the costs of care. It means free personal care. Better pay and conditions for social care workers. More support for unpaid carers. Greater integration with health. Reduced pressure on the NHS.
This change is about infrastructure. Systems. Bureaucracies. Sustainable funding solutions. It’s big. Massive. Beyond our control. And so we wait.
Or do we?
There’s a growing recognition that the reform we need in adult social care isn’t just about money. It’s a change we can’t buy. And it’s a change we can’t wait for.
This change is a shift from ‘doing to’ to ‘working with’. From assessments to conversations. From assuming and telling, to listening and understanding. From asking ‘what’s the matter?’ and ‘what’s wrong?’, to ‘what matters?’ and ‘what’s strong?’. From transactions and services, to relationships and connections. From caring for people and fixing problems with our solutions, to caring about what people care about, and supporting them to live the life they want to lead.
This change is about being curious, and kind, and human. It’s about people. This change is big too, but it’s well within our control. And we can start now, by changing the language we use to communicate with and about people, and by changing how we talk about social care.
Too much of our language is about ‘them’. Others. If you receive social care, you’re ‘vulnerable’. A ‘service user’, a reference number or a ‘case’. Not quite human. And what you do is different too. You need help with ‘toileting’, ‘mobilising’, ‘accessing the community’ and ‘maintaining relationships’. You live (we ‘place’ you) in a ‘unit’, a ‘setting’ or a ‘scheme’. You have ‘activities’ to do, ‘outcomes’ to achieve and ‘independence’ to maintain.
We define you and relate to you by the box we fit you in to. We identify you by your ‘primary support reason’ or by the way we process you. ‘LD’. ‘Mental health’. ‘Eligible’. ‘A referral’. ‘A respite’. ‘A DOLS’. ‘Bed 7’.
You’re different. Not like us. We’re ‘professionals’. ‘Assessors’. ‘Care managers’. Our job titles clearly demonstrate our relationship with you and where the power lies.
And we’re quick to blame you too. You’re ‘complex’. ‘Challenging’. ‘Non-compliant’. ‘Hard to reach’. You ‘refuse to engage’. You’re an ‘inappropriate referral’. Your family is ‘difficult’. ‘Hostile’. ‘Uncooperative’.
You’re the problem. We’re the solution.
Does that seem too extreme? Maybe, but too often that’s the message we’re communicating. Our language is so deeply entrenched that we don’t think about the meaning of the words we use, or acknowledge their real impact. But our labels and jargon and acronyms distance and exclude. They separate and blame. Stereotype and label. Stigmatise and wound.
The Oxford English Dictionary definition of ‘rewriting’ is ‘to write (something) again so as to alter or improve it’. I firmly believe that we can rewrite social care to significantly alter and improve it, by changing the words and phrases we use to communicate with and about people in our conversations and our records and our letters and our reports. By talking and writing about people as human beings, and by being more human in the way we talk and write about people.
Obviously just changing our language is not enough. Genuine aspirations quickly become buzzwords, then rapidly turn into ironic, meaningless jargon when the only change is the language we use.
There’s not much room for ‘personalisation’ in our standard assessment questions, or our linear processes, or our one-size fits all service solutions. Talking about ‘strengths-based approaches’ doesn’t sit comfortably in a system which still operates on deficits and labels. ‘Choice’ is vital, but choice between two different institutions isn’t good enough. ‘Coproduction’ is meaningless when it’s a tick-box exercise to validate a decision already taken or a plan already made. ‘Empowerment’ is patronising unless power is genuinely shared, and everyone has an equal voice. ‘Asking what matters is essential’, but we have to do what matters too. Being ‘person-centred’ only works when we actually identify the people we’re working with as people, and when we act like humans too.
But unless we change our language, we’ll never achieve the change we want to see. We need to embed our commitment to a better, brighter social care future in the words we choose to use. Language is powerful. If we genuinely believe in sharing power, we need to remove the barriers we’ve created through our jargon and adopt a shared language. If we want to be more curious, we need to stop applying labels and all the associated assumptions and stereotypes and judgements they bring. If we’re serious about being more kind, we need to stop blaming and shaming, and use words that demonstrate our compassion. If we’re committed to being more inclusive, we need to stop distancing and excluding people with our words.
And we need to change the words and images we use to communicate about social care too. We need to shift the narrative from crisis and the cost of care, to the potential and value of support. We need to drop the ticking time-bomb metaphors and the images of wrinkly hands, and tell a different story, based on what’s strong – not what’s wrong.
Rewriting social care isn’t about finding a new language. We don’t need more jargon. But there are words and phrases and images that we need to leave behind, and others we must use more. And as such, rewriting social care is about adopting a common language. A shared vocabulary, that opens doors, builds relationships, celebrates diversity and recognises possibility. A social care future about people and promise, not processes and problems. About all of us, not ‘them’ and ‘us’. A future we’re proud to be part of, and excited to talk about. A future worth investing in.
This blog post was written for Social Care Today, and published as How should social care be rewritten? on 20 April 2020.